Advanced Practice Registered Nurse Update

The Issue

2014 and 2015 have been be busy years for nurse practitioners (NPs) and defining their scope of practice. Although there are 20 states plus the District of Columbia that allow full practice authority, there are still some states that do not. Of note, even in states that have full practice authority, scope of practice may be limited by medical or hospital bylaws within healthcare facilities.

The Research

Research has demonstrated the NPs provide care that is comparable or better than care provided by MDs alone. A meta-analysis of 37 studies looked at and compared outcomes of several different measures for MDs and NPs and the results were similar (Stanik-Hutt et al., 2013).

Current Legislation

There are several bills at the national level:

• The Home Health Planning and Improvement Act (S.578/H.R.1342), which would allow NPs to endorse a patient’s eligibility for home care;
• Veteran’s Access to Quality Care Act (H.R. 1247) and Frontlines to Lifelines Act of 2015 (S.297), which would allow NPs to practice at the top of their scope in VA facilities
• Ensuring Access to Primary Care for Women and Children Act (S.737/H.R.2253).

The following are bills at the state level:

• California is working to pass S.B. 323, which would expand the scope of practice of NPs.
• Colorado S.B.197 passed. This removed the 3600-rule that prohibited provisional prescriptive authority until a new graduate had worked 1,800 hours. This new bill allows new graduate NPs to have provisional prescriptive authority at the time of registration as an APRN with the State Board of Nursing.
• Maryland S.B.723/H.B.99 removed the requirement for an NP to have a collaborative agreement with a physician.

Recommendations

1. Advocate for full-practice authority in states where it is not already in place.
2. Educate the public, patients, and families, about the role of the NP.
3. Monitor federal and state legislation that may have an impact on scope of practice.
4. Familiarize oneself with state board of nursing or state medical board regulations that dictate scope of practice.
5. Become an active member of the Healthcare Policy and Advocacy Committee.

References

1. Stanik-Hutt J, Newhouse RP, White KM, Johantgen M, Bass EB, Zangaro G, Wilson R, Fountain, L, Steinwachs, DM, Heindel, L, Weiner, JP. The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners. 2013;9(8): 492–500.
2. Oliver GM, Pennington L, Revelle S, Rantz M. Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nurs Outlook. 2014:62(6):440–7.